Original article
Irregular Menses Linked to Vomiting in a Nonclinical Sample: Findings from the National Eating Disorders Screening Program in High Schools

https://doi.org/10.1016/j.jadohealth.2007.11.139Get rights and content

Abstract

Purpose

Using data from an eating disorders screening initiative conducted in high schools across the United States, we examined the relationship between vomiting frequency and irregular menses in a nonclinical sample of adolescent females.

Methods

A self-report questionnaire was administered to students from U.S. high schools participating in the National Eating Disorders Screening Program in 2000. The questionnaire included items on frequency of vomiting for weight control in the past 3 months, other eating disorder symptoms, frequency of menses, height, and weight. Multivariable regression analyses were conducted using data from 2791 girls to estimate the risk of irregular menses (defined as menses less often than monthly) associated with vomiting frequency, adjusting for other eating disorder symptoms, weight status, age, race/ethnicity, and school clusters.

Results

Girls who vomited to control their weight one to three times per month were one and a half times more likely (risk ratio [RR] = 1.6; 95% confidence interval [CI] = 1.2–2.2), and girls who vomited once per week or more often were more than three times more likely (RR = 3.2; 95% CI = 2.3–4.4), to experience irregular menses than were girls who did not report vomiting for weight control. Vomiting for weight control remained a strong predictor of irregular menses even when overweight and underweight participants were excluded.

Conclusions

Our study adds to the evidence that vomiting may have a direct effect on hormonal function in adolescent girls, and that vomiting for weight control may be a particularly deleterious component of eating disorders.

Section snippets

Methods

The national nonprofit organization, Screening for Mental Health, that led the initiative sent notices to high schools across the country inviting them to participate in the one-time screening program in 2000. Of the 270 public, private, and parochial schools that enrolled in NEDSP, 152 high schools from 34 U.S. states administered the screening instrument to their students. Of these participating schools, 98 returned completed screening forms for data analysis by Screening for Mental Health.

Results

Table 1 presents selected characteristics, eating disorder symptoms, and menstrual irregularity in the full sample and subsample of girls with BMI in the low–moderate/moderate weight range. For the full sample, the mean age was 15.8 years, and 85.8% were of white race/ethnicity. Vomiting one to three times per month to control their weight in the previous 3 months was reported by 8.9% of girls, and an additional 3.1% reported vomiting once per week or more often. More than 14% of the girls

Discussion

In a national eating disorders screening initiative in U.S. high schools, we found a strong association between vomiting frequency and irregular menses in adolescent females aged 14–19 years. When restricting analyses to girls within a healthy weight range, the associations persisted at a similar magnitude, indicating that vomiting, rather than anthropometric characteristics such as extreme BMI, may be likely to explain observed associations. In girls within the low–moderate/moderate weight

Acknowledgments

The authors acknowledge Nancy Conlon, S. Jean Emans, Barbara Kopans, Joelle Riezes, David Wypij, Anne Zachary, the Massachusetts Eating Disorder Association, and the NEDSP advisory board for their contributions. Thanks are also extended to the thousands of students, faculty, and staff from high schools across the country who made the screening program possible. The National Eating Disorders Screening Program was funded by the McKnight Foundation. This work was supported by the McKnight

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